\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n Just days after his firing of the brand-new director of the Centers for Disease Control and Prevention, a defiant Robert F. Kennedy Jr., the U.S. secretary of health and human services, defended that action and others before a sometimes skeptical Senate Finance Committee. Criticism of Kennedy\u2019s increasingly anti-vaccine actions came not just from Democrats on the panel but from some Republicans who are also medical doctors.<\/p>\n Meanwhile, members of Congress have only a few weeks left to complete work on spending bills or risk a government shutdown, and time is also running out to head off the large increases in premiums for Affordable Care Act health plans likely to occur with additional Biden-era government subsidies set to expire.<\/p>\n This week\u2019s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Sarah Karlin-Smith of Pink Sheet, and Alice Miranda Ollstein of Politico.<\/p>\n \t\t\t \tJessie Hellmann \t\t\t \t\t\t \t\t\t \t\t\t \tSarah Karlin-Smith \t\t\t \t\t\t \t\t\t \t\t\t \tAlice Miranda Ollstein \t\t\t \t\t\t \t\t\t Among the takeaways from this week\u2019s episode:<\/p>\n Also this week, Rovner interviews KFF Health News\u2019s Tony Leys, who discusses his \u201cBill of the Month\u201d report about a woman\u2019s unfortunate interaction with a bat \u2014 and her even more unfortunate interaction with the bill for her rabies prevention treatment.<\/p>\n Plus, for \u201cextra credit\u201d the panelists suggest health policy stories they read this week that they think you should read, too:<\/p>\n Julie Rovner:<\/strong> ProPublica\u2019s \u201cGutted: How Deeply Trump Has Cut Federal Health Agencies<\/a>,\u201d by Brandon Roberts, Annie Waldman, and Pratheek Rebala.<\/p>\n Jessie Hellmann:<\/strong> KFF Health News\u2019 \u201cWhen Hospitals and Insurers Fight, Patients Get Caught in the Middle<\/a>,\u201d by Bram Sable-Smith.<\/p>\n Sarah Karlin-Smith:<\/strong> NPR\u2019s \u201cLeniency on Lice in Schools Meets Reality<\/a>,\u201d by Blake Farmer.<\/p>\n Alice Miranda Ollstein:<\/strong> Vox\u2019s \u201cExclusive: RFK Jr. and the White House Buried a Major Study on Alcohol and Cancer. Here\u2019s What It Shows<\/a>,\u201d by Dylan Scott.<\/p>\n Also mentioned in this week\u2019s podcast:<\/p>\n \t\t\t\t\tclick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: On Capitol Hill, RFK Defends Firings at CDC\t\t\t\t<\/p>\n [Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> Hello, and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent for KFF Health News, and I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Friday, Sept. 5, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go.\u00a0<\/p>\n Today we are joined via videoconference by Sarah Karlin-Smith of the Pink Sheet.\u00a0<\/p>\n Sarah Karlin-Smith:<\/strong> Hi, everybody.\u00a0<\/p>\n Rovner:<\/strong> Alice Miranda Ollstein of Politico.\u00a0<\/p>\n Alice Miranda Ollstein:<\/strong> Hello.\u00a0<\/p>\n Rovner:<\/strong> And Jessie Hellmann of CQ Roll Call.\u00a0<\/p>\n Jessie Hellmann:<\/strong> Hi there.\u00a0<\/p>\n Rovner:<\/strong> Later in this episode, we\u2019ll have my interview with my KFF Health News colleague Tony Leys, who reported and wrote the August \u201cBill of the Month\u201d about a patient\u2019s unfortunate run-in with a bat and an even more unfortunate run-in with the bill for rabies prophylaxis. But first, this week\u2019s news.\u00a0\u00a0<\/p>\n Well, it is safe to say that there has been quite a bit of health news since we last met in mid-August. Health and Human Services Secretary Robert F. Kennedy Jr. testified before the Senate Finance Committee yesterday, which we will talk about in a moment. But first, I want to catch us up on what you might\u2019ve missed. Our story starts, kind of, with the FDA\u2019s [Food and Drug Administration\u2019s] approval of this year\u2019s covid boosters, which are only being licensed for those over age 65 and those who are younger but have at least one condition that puts them at high risk of serious illness if they contract the virus. That leaves out lots of people that many doctors think ought to be boosted, like pregnant women and children. Sarah, what\u2019s supposed to happen after the FDA acts? The next step happens at CDC [the Centers for Disease Control and Prevention], right?\u00a0<\/p>\n Karlin-Smith:<\/strong> Correct. So right now the CDC\u2019s Advisory Committee on Immunization Practices is scheduled to meet Sept. 17 to 18, 18 to 19, but about two weeks from now. And they would typically vote on sort of endorsing use of these vaccines and, again, have like sort of a second chance to weigh in on which populations they would be used for. And that\u2019s often important for triggering insurance coverage without copays. And also many states rely on the CDC recommendations for various state laws that say, again, who can get the vaccine or whether you can get it via a pharmacist or only at a doctor\u2019s office, do you need a prescription, and things like that. So the CDC and FDA, I would say, in general is a little bit behind this year. I could think a lot of people have been trying to go out and get these new shots even though those steps haven\u2019t happened yet.\u00a0<\/p>\n Rovner:<\/strong> That\u2019s right. I mean, it is early. Even if there was nothing else going on, there is that little bit of a lag between when FDA acts and when the CDC acts, right?\u00a0<\/p>\n Karlin-Smith: <\/strong>Yeah, there usually is. I think in the past they\u2019ve tried to have both FDA approval and the CDC act so that the vaccines could start rolling out more like late summer, early September. So they\u2019re definitely behind, and there\u2019s been a number of reports of covid kind of slowly rising as the summer winds down and school gets back in session.\u00a0<\/p>\n Rovner:<\/strong> Yeah, so there\u2019s a lot of other things going on. Well, in the meantime, nothing that was supposed to happen has happened yet, and we still don\u2019t know all the details, but it certainly appears that Susan Monarez, who was just confirmed by the Senate to lead the CDC a month ago, was fired after she refused to override her scientific advisers and approve the new restrictions on covid vaccine availability, even before the ACIP met. In turn, four top CDC leaders resigned as well, going public to warn that the agency is being politicized by the secretary. How much of a mess is the CDC in right now? And how long is it going to take to put the pieces back together?\u00a0<\/p>\n Karlin-Smith: <\/strong>I think they\u2019re in a pretty bad place, because not only did they lose their director really quickly, but after she resigned, about I think it was eight or nine senior CDC leaders resigned last week as well. And so, really critical people to various parts of the operation that you don\u2019t just replace very easily. And Kennedy has slotted in Jim O\u2019Neill as the temporary director of the CDC and kind of indicated he wants to remake the agency. And I think there are questions as to how that remaking shapes both its priorities and how it handles public health throughout the U.S.\u00a0<\/p>\n Rovner:<\/strong> And of course, morale at CDC is awesome, in part because, as we discussed the last time we met, a gunman came and shot up the place, killing a policeman and leaving the staff pretty upset. And that gunman, who then took his own life, was later found to have had some discontent with vaccines. So things are just really bright and cheery there in Atlanta at the CDC. Alice, I see you nodding.\u00a0<\/p>\n Ollstein:<\/strong> These things kind of snowball, you know? I think there are likely to be a lot of staff who were already on the fence about staying and decided to stay because they trusted these pretty senior leaders with a lot of decades of expertise and institutional knowledge. And that was sort of the thread they were hanging on as well, at least: I\u2019m with these people.<\/em> And now that they\u2019ve left, I think that could trigger a bigger exodus on top of the exodus that was already underway.\u00a0<\/p>\n Rovner:<\/strong> And it\u2019s important to say \u2014 even though we say it, I think, every time \u2014 that these are career scientists who\u2019ve worked for Democrats and Republicans over the years. These are not generally political people. They\u2019re not political appointees. And they basically do their jobs. And until fairly recently, public health wasn\u2019t this partisan, so it wasn\u2019t that hard to be a career public health official just working for public health. That\u2019s just not the case anymore, is it?\u00a0<\/p>\n Karlin-Smith: <\/strong>I think there\u2019s been a lot of insult to injury added with what happened with the shooting at the CDC, because there is a sense that the kind of rhetoric that Kennedy in particular has used over the years, even before he came into HHS [the Department of Health and Human Services], on sort of his movement has sort of amplified the criticism of public health workers and put them in this situation where they\u2019re dangerous. And Kennedy, instead of really acknowledging that and maybe apologizing or giving any sense that he was going to shift in a different direction, has actually really kind of doubled down on it. And even in some of the pieces he\u2019s written recently about how he wants to reform the CDC, he kind of keeps criticizing the rank-and-file employees and so forth. So there\u2019s a lot of tension between the political leadership and the career staff, I think, at this moment.\u00a0<\/p>\n Ollstein:<\/strong> And in normal times, most of the American public would not even know the names of these people. They\u2019re not public figures. They\u2019re just very behind-the-scenes scientists doing their work. And now their personal photos are being combed through and shared to attack them because they\u2019ve criticized the administration. They\u2019re getting threats. It\u2019s just this whole level, like you said, of politicization that we haven\u2019t seen before.\u00a0<\/p>\n Rovner:<\/strong> Well, so, in kind of a coincidence, Kennedy had already agreed to appear on Thursday before the Senate Finance Committee, which by the way doesn\u2019t have jurisdiction over the CDC or the rest of the public health service. But no matter \u2014 a Senate hearing is a Senate hearing. And let\u2019s just say it didn\u2019t go that well for the secretary. Democrats were kind of withering in their criticism of Kennedy\u2019s eight-month tenure so far. Here\u2019s Colorado Sen. Michael Bennet.\u00a0<\/p>\n Sen. Michael Bennet:<\/strong> This is the last thing, by the way, our parents need when their kids are going back to school, is to have the kind of confusion and expense and scarcity that you\u2019re creating as a result of your ideology.\u00a0<\/p>\n Rovner:<\/strong> Republicans weren\u2019t that impressed, either, particularly the Republicans on the committee who are also doctors. [Sen.] Bill Cassidy, a doctor who\u2019s on Finance but is also the chairman of the Health, Education, Labor, and Pensions Committee and is facing a primary challenge in Louisiana, seemed to tread pretty carefully. More surprising, at least to me, was Dr. Sen. John Barrasso of Wyoming, who\u2019s also in the Senate leadership.\u00a0<\/p>\n Sen. John Barrasso:<\/strong> So over the last 50 years, vaccines are estimated to have saved 154 million lives worldwide. I support vaccines. I\u2019m a doctor. Vaccines work.\u00a0<\/p>\n Rovner:<\/strong> I was super impressed that even the Republicans who criticized RFK were careful not to criticize President [Donald] Trump. In fact, there were several suggestions \u2014 this was clearly a talking point \u2014 that Trump should be given a Nobel Prize for his work overseeing Operation Warp Speed, just so the senators could kind of bifurcate their complaints. What impact, if any, is this hearing going to have on RFK\u2019s future as secretary?\u00a0<\/p>\n Ollstein:<\/strong> Well, I think there was an attempt to, I think, what you just mentioned. That like dual criticism with praise of Trump was meant to drive a wedge and to get Trump to question RFK\u2019s leadership. That does not seem to have worked so far. We don\u2019t know what\u2019s going to happen in the future, but I think it\u2019s an attempt to get the message to Trump that RFK\u2019s reputation and actions could be damaging to the administration overall. And there was some reporting that polling showing that most people do support vaccines was circulated amongst Republican members before the hearing. And so, I think it\u2019s trying to, yeah, get the message that this is both damaging in a public health sense but also potentially damaging in a political sense as well.\u00a0<\/p>\n But so far, the reporting is that Trump is standing by RFK, that he liked how combative he was. And so I don\u2019t know where those attempts to drive a wedge will go in the future, but like you said, it was notable that if folks like Barrasso, [Sen. Thom] Tillis, who\u2019s not running for reelection, was also more vocally critical, and a couple others, not a lot. We\u2019re not seeing a great dam breaking yet. But I think there\u2019s more cracks than there used to be on the GOP side.\u00a0<\/p>\n Rovner:<\/strong> I did notice that Trump, he had a very strange Truth Social post earlier in the week that basically said that CDC is a mess and it has to be fixed<\/em>. Kind of just Trump being the omniscient observer. And then, apparently at a dinner with tech titans after the hearing, he said that he had not watched the hearing but that he heard that Kennedy did well, which is not exactly what I would call a ringing endorsement. I feel like Trump is giving himself some runway to go either way depending on sort of how things continue to shake out. I see nodding.\u00a0<\/p>\n Karlin-Smith: <\/strong>Yeah. I saw a lot of people reposting that clip on social media last night who are frustrated with Kennedy and using it to try and ramp up their banks and say: Keep calling. Keep pressuring. This shows we have an opening.<\/em> I think it\u2019s really always hard to read the tea leaves with Trump and his language and words. He\u2019s a harder person to interpret. But I also thought it was really interesting that in some ways Cassidy and some of the other Republicans were throwing RFK a bone and saying: This is your president. This was his greatest achievement. Can you support it?<\/em>\u00a0<\/p>\n And RFK couldn\u2019t even really twist himself into doing that. He sort of tried to, but he could never square it with the bulk of his remarks at the hearing, which were incredibly critical. MRNA vaccines and vaccines in general \u2014 he defended the massive cuts in this area for research. He defended people who have really said very untrue things about the harm caused by these vaccines. So in some ways I felt like Cassidy was trying to give him one more chance or something, and RFK couldn\u2019t even take it when it was couched as this Trump achievement.\u00a0<\/p>\n Rovner:<\/strong> I can\u2019t help but wonder if this is playing to Trump\u2019s advantage because it\u2019s distracting from Trump\u2019s other problems, that perhaps Trump likes that there\u2019s so much attention on this because it takes attention away from other things.\u00a0<\/p>\n Ollstein:<\/strong> Yeah. Although I do find the eagerness of Democratic members of Congress and other folks to wave away certain things as a distraction as a little bit questionable. This is all part of the agenda of the administration, and dismantling government bureaucracy is clearly a core, core part of the administration\u2019s agenda, and so\u2014\u00a0<\/p>\n Rovner:<\/strong> And flooding the zone.\u00a0<\/p>\n Ollstein:<\/strong> Exactly. Well, it might also<\/em> serve as a distraction. I think that it should be considered a serious part of what they actually want to do as well.\u00a0<\/p>\n Rovner:<\/strong> So there were a couple of things that we learned about RFK Jr. from his confirmation hearings back in the winter. One is that he\u2019s not at all deferential to elected officials, even calling them liars, which is pretty unheard of. And that he doesn\u2019t really know how his department works. And it appears that eight months later, neither of those things have changed. How does he get away with being so rude? I mean, I\u2019ve just never seen a Cabinet official who\u2019s been so undeferential to the people who basically put him in office. Is it just me?\u00a0<\/p>\n Karlin-Smith: <\/strong>I think it\u2019s part of the times where politics is really trumping behavior or policy, right? Even though there were a few Republicans that we\u2019ve talked about who have kind of started to get frustrated with RFK and his vaccine policies. You saw at the beginning of the hearing, Chairman [Mike] Crapo was asked by the ranking Democrat, Sen. [Ron] Wyden, to basically swear Kennedy in because Wyden has felt like Kennedy has lied to the committee before. And Crapo just basically brushed that away and dismissed it. And I think, so, in many ways a lot of the Republicans on the committee endorsed Kennedy\u2019s behavior kind of, maybe not overtly but indirectly, and that\u2019s sort of been how they\u2019ve been operating. It\u2019s more of a political theater thing, and they\u2019re OK with sort of this disrespect, of its sort of political fight that somebody on their side is taking up.\u00a0<\/p>\n Ollstein:<\/strong> I also think Congress\u2019 unwillingness so far to actually sanction or take action in any way about anything RFK has done seems to have emboldened him. I think the fact that he has broken all these promises he made to Cassidy and other senators and there have been basically no consequences for him so far feeds into that. He kind of has a What are you going to do?<\/em> attitude that was very evident in the hearing.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think that\u2019s fair. Well, there were, as always, parochial question from senators about home state issues, but one topic I don\u2019t think I expected to see come up as many times as it did was the future of the abortion pill, mifepristone, which is about to celebrate the 25th anniversary of its original approval by the FDA. Alice, what are you hearing about whether FDA is going to rein the drug back in, which is what a lot of these anti-abortion Republicans really want to see happen?\u00a0<\/p>\n Ollstein:<\/strong> Yeah, so I think there was nothing new in the hearing this week. What he said was what he\u2019s been saying, that they\u2019re looking into it, that they\u2019re evaluating. He made no specific commitments. He gave no specific timelines. He said basically enough to keep the anti-abortion people thinking that they\u2019re cooking up some restrictions but not explicitly promising that, either. And so I think we\u2019re just where we were before. They continue to reference data put forward by an anti-abortion think tank that was not peer-reviewed and claiming that it is this solid scientific evidence, which it is not, about the risks posed by the pills, which many actual, credible, peer-reviewed studies have found to be very safe. And so we just don\u2019t know what\u2019s going to happen. I think any nationwide restrictions, which is what they\u2019re mulling at the federal level, which would impact states where abortion is legally protected, that would be a potentially politically damaging move. And so it\u2019s understandable why they might not want to pull that trigger right now. So, right.\u00a0<\/p>\n Rovner:<\/strong> And Trump has said, I mean, Trump has indicated that he does not really want to wade into this.\u00a0<\/p>\n Ollstein:<\/strong> Correct. But again, he\u2019s also very good about not making hard promises in either direction and sort of keeping his options open, which is what they\u2019re doing. The anti-abortion activists, this is not their only iron in the fire. This is just one of many strategies they have going on. They also have multiple pending lawsuits and court cases that are attempting to accomplish the same thing. They\u2019re pursuing new policies at the state level, which we\u2019ll probably talk about, Texas and others.\u00a0<\/p>\n Rovner:<\/strong> Next.\u00a0<\/p>\n Ollstein: <\/strong>And so yes, this pressure on FDA and HHS to use regulation to restrict the pills is only one of many ongoing efforts.\u00a0<\/p>\n Rovner:<\/strong> Well, you have anticipated my next question, which is that while we are on the subject of the abortion pill, Texas, because it is always Texas, has a new bill on its way to the governor for a signature to try to outlaw telemedicine prescribing of the abortion pill<\/a>. What exactly would this Texas law do? And would it work? Because, obviously, this has been the biggest loophole about stopping abortion in these states that have banned abortion, is that people are still able to get these pills from other states via telemedicine.\u00a0<\/p>\n Ollstein:<\/strong> Yeah. So in one sense, nothing\u2019s changed. Abortion was already illegal in Texas, whether you use a pill or have a procedure. And so this is just layered on top of that. The groups who backed this explicitly said the attempt is to have a chilling effect. What they\u2019re hoping is that no lawsuits are even needed, because this just scares people away from ordering pills and scares groups in other states away from sending pills. One concern that I saw raised is that the law criminalizes simply the shipping of the pills. Somebody doesn\u2019t even have to take them for a crime to have been committed.\u00a0<\/p>\n And so that\u2019s raising concerns that anti-abortion activists will do kind of sting operations, sort of entrapment-y things where they order the pills solely in the interest of bringing a lawsuit. Because there is a cash bounty that you can get for filing a lawsuit \u2014 there\u2019s an incentive. So that\u2019s a concern. And then just the general concern of a chilling effect and people who are using less safe means than these pills to terminate their pregnancies out of fear, which studies have shown is already on the rise, people injuring themselves taking herbs and other substances, chemicals. So that\u2019s a concern as well.\u00a0<\/p>\n Rovner:<\/strong> We\u2019ll continue to watch this, but back to vaccine policy. With the status of federal vaccine recommendations in limbo, states appear to be going their own way. Blue states California, Washington, and Oregon are banding together in a consortium to make official recommendations in the absence of federal policy, and several blue-state governors are acting unilaterally to make sure covid vaccines, at least, remain available to most people. At the same time, some red states are going the other way, with Florida Surgeon General Joseph Ladapo, who we have talked about before, now vowing to get rid of all vaccine requirements<\/a> for schoolchildren. Sarah, that would be a really big deal, right?\u00a0<\/p>\n Karlin-Smith: <\/strong>Right. I think the big fear then is that the school requirements is kind of what gets us to close to, in many cases, universal vaccine uptake in the country, because everybody needs their kids to be in school. Unless you\u2019re homeschooled, you really must follow these vaccine requirements. And it not only hurts the kids who don\u2019t end up getting vaccinated individually, but it can really hurt the idea of herd immunity and the protection we need for these diseases to disappear in the community. So there\u2019s\u2014\u00a0<\/p>\n Rovner:<\/strong> And protection for people who can\u2019t be immunized for some reason.\u00a0<\/p>\n Karlin-Smith: <\/strong>Right. Who either can\u2019t be immunized or don\u2019t have an adequate response to the immunization because they\u2019re going through cancer treatment or they have some other medical reason that their body is immunocompromised.\u00a0<\/p>\n Rovner:<\/strong> So, I mean, is this going to end up like abortion, where it\u2019s availability absolutely depends on where you live?\u00a0<\/p>\n Karlin-Smith: <\/strong>I think that\u2019s hard to say. I think that a policy like what Florida is trying to implement could very quickly and easily go wrong, I think, and be reversed, as we\u2019ve seen, like what\u2019s happening in Texas now, with measles outbreaks. You know you only need just very small fractions of decreases in vaccination to create huge public health crises in places. And so I think it would be more sort of visible, in a way, to some of these states and their populations, the potential harm that could be caused, than maybe it is to them the abortion harm. But we definitely are seeing some sense of, right, the Democratic-controlled states trying to implement policies that help people get better access to vaccines, even when the federal government is trying to maybe harm that, and red states not caring as much.\u00a0<\/p>\n So there is going to be some more of a patchwork. And I feel like, in talking to just sort of people outside of the health policy space, there is a lot of confusion about: Where can I get my covid vaccine? Am I going to have to pay? Do I qualify?<\/em> Especially being in D.C., which has less generous, I guess, pharmacy laws, because of this. So people are confused. If I go to Maryland, which is really close, does that matter even though I live in D.C.?<\/em> And it\u2019s just all these things we kind of know end up leading to less people getting vaccinated. Because even if they want to do it, the hurdles end up driving people away.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I think something you\u2019d said earlier about the fact that we\u2019re seeing kind of a covid spike, so people are anxious to get covid vaccines, I think, a little bit earlier than normal. It\u2019s usually kind of a fall thing and it\u2019s only the beginning of September, but I think there\u2019s just this combination, this confluence of events that has a lot of people very excited about this right now.\u00a0<\/p>\n Karlin-Smith: <\/strong>Yeah, I think it does. And covid has been, I think there\u2019s been lots of hope in the public health world that covid would become a little bit like the flu, where we could predict a little bit more when it would really peak and get everybody vaccinated around the same time as they\u2019re getting flu vaccines. Just again, because we know when we make it easier on people to get vaccinated, if you could just one-and-done it, it would be good. Unfortunately, covid has tended to also still have summer peaks, and this year again it\u2019s kind of a late summer peak. And a lot of people, including seniors, are still recommended really actually to get two vaccines a year. So many people are kind of coming due for that second update right now.\u00a0<\/p>\n Rovner:<\/strong> Well, we\u2019ll keep watching that space. Moving on, as we kind of pointed out already, Congress is back in town, with just a couple weeks to go before the start of fiscal 2026 on Oct. 1. This was the year Congress was really, truly going to get all of its spending bills passed in time for the start of the new year. How\u2019s that going, Jessie?\u00a0<\/p>\n Hellmann:<\/strong> It\u2019s going great. I\u2019m just kidding. There\u2019s a lot of friction on the Hill right now. The White House budget chief is talking about doing more clawbacks of foreign aid, which is frustrating both Democrats and Republicans. It\u2019s about $5 billion, and we\u2019re seeing Democrats kind of start to put their neck out there a little more than they did earlier in the year when they were also kind of making noise about government funding. And they\u2019re now saying that Republicans are going to have to go this alone and they\u2019re not going to support partisan spending bills. So it\u2019s kind of difficult to see where we go from here. And then\u2014\u00a0<\/p>\n Rovner:<\/strong> Are we looking at a shutdown on Oct. 1? I mean, that\u2019s what happens if the spending bills aren\u2019t done.\u00a0<\/p>\n Hellmann:<\/strong> It\u2019s hard to say. There might be a short-term spending bill, but anything longer-term than that, it seems really difficult at this point. And there are just massive differences between the health bills that the House came out with and the Senate came out with. I mean, there\u2019s differences in all the other appropriations bills, too, but I was just going to focus on health.\u00a0<\/p>\n Rovner:<\/strong> Yes, please.\u00a0<\/p>\n Hellmann:<\/strong> The Senate bill would allow an increase for HHS, and the House bill would cut it pretty significantly. So it\u2019s kind of hard to see how they could do anything more substantive when there\u2019s so much light between the two.\u00a0<\/p>\n Rovner:<\/strong> Yeah. I mean, on the one hand, we have both the Senate and the House subcommittee that\u2019s marked up the Labor HHS [Labor, Health and Human Services, Education, and Related Agencies] appropriation on record as not supporting at least the very deep cuts to the National Institutes of Health that were proposed by President Trump. But on the other hand, as you mentioned, we still have the administration, primarily budget office chief Russell Vought, making the case that the administration doesn\u2019t have to spend money that Congress appropriates. And from all we can tell, at least as of now, there\u2019s a lot of money that won\u2019t be spent as of the end of the fiscal year, despite the fact that that is illegal. It\u2019s known as a pocket rescission, a term I think we\u2019re about to hear a lot more about. Alice, you referred to this earlier: Is Congress just going to quietly ignore the fact that the administration is usurping their power?\u00a0<\/p>\n Ollstein:<\/strong> I think that in many areas of politics, there is a faction that wants to play hardball and really use whatever leverage is possible and there\u2019s a faction that wants to play nice and try to get what they can get by negotiation. And I think both parties always fear being blamed for shutdowns, and so that drives a lot of it. But I think there\u2019s mounting frustration with Democratic leadership about not playing hardball enough. I mean, the jokes I hear are Democrats like to bring a spreadsheet to a gunfight, just seen as being unwilling, in the face of what many see as lawlessness, being unwilling to really put a check on that using the levers they have, including this federal spending. But I think we\u2019ve seen that there are risks no matter what they do, and so I think people make reasonable points about the pros and cons of various strategies.\u00a0<\/p>\n Rovner:<\/strong> Well, we know that [Sen.] Susan Collins, who\u2019s now the chair of the Senate Appropriations Committee, is very, very concerned \u2014 because Susan Collins is always very, very concerned. But she\u2019s the one whose power is basically being thwarted at this point. People have gotten a lot of gray hair waiting for Susan Collins to stand up and be combative, but one would think if there was ever a time for her to do it, this would be it. Jessie, are we seeing, I was going to say, any indication that the appropriators are going to say, Hey, this is our job and our constitutional responsibility, and you\u2019re supposed to do what we say when it comes to money<\/em>?\u00a0<\/p>\n Hellmann:<\/strong> They are saying these things. I feel like we are seeing more Senate Republicans, at least, express discomfort with what the Trump administration is doing, saying things like: This is Congress\u2019 job. We have the power of the purse.<\/em> And then they are passing some of these spending bills through committee. But what else are they supposed to do? Unless Susan Collins wants to get on Fox News and start screaming about government funding, which I don\u2019t really see happening and I don\u2019t know if it would be effective, you kind of just wonder: What other options do they have at this point?\u00a0<\/p>\n Rovner:<\/strong> Yeah. Well, we\u2019ll sort of see how this plays out over the next few weeks. Meanwhile, it\u2019s not just the spending bills that Congress is facing deadlines for. This month is basically the last chance to re-up those, quote, \u201cexpanded subsidies\u201d for Affordable Care Act plans before the sticker shock hits 24 million people in the face. Not only are premiums going up by an average of 18% from this year to next \u2014 that\u2019s for a lot of reasons: increasing costs of health care, tariffs, drug prices \u2014 but eliminating those additional subsidies, or actually letting them expire, will cause some people to have to pay double or triple what they pay now. And it\u2019s going to hit folks in red states like Georgia and Florida and Texas even harder because more folks there are on the Affordable Care Act plans, because those states didn\u2019t expand Medicaid. Do Republicans not understand what\u2019s about to happen to them?\u00a0<\/p>\n Hellmann:<\/strong> I think they understand, but they keep acting like there\u2019s no urgency to the situation. They keep saying: We still have time. We have till the end of the year.<\/em> Which I guess is technically true, but we\u2019re already seeing insurers proposing these giant rate hikes. And it\u2019s not easy to just go back and make changes to some of this. I guess the idea is\u2014\u00a0<\/p>\n Rovner:<\/strong> So they really don\u2019t have until the end of the year, though. Because people are going to get, they\u2019re going to see the next year\u2019s premiums that they have to start signing up in November. So, I mean, they basically have this month.\u00a0<\/p>\n Ollstein:<\/strong> If there\u2019s uncertainty, they\u2019re going to price very conservatively, aka high. They don\u2019t want to be left holding the bag. And so, yeah, you and Jessie are exactly right that there isn\u2019t time. These decisions are being made now. Even if they pass something to kick the can until after the midterms, I think some damage will already have been done.\u00a0<\/p>\n Rovner:<\/strong> Yeah. Jessie, I cut you off, though. I mean, the idea is that sort of their one chance to maybe do this before people actually start to get these bills, or at least see what they\u2019re going to have to pay, would be wrapped into this end-of-fiscal-year continuing resolution. And maybe they can kick the appropriations down the road until November or December, but they can\u2019t really kick the question of the subsidies down the road until November or December.\u00a0<\/p>\n Hellmann:<\/strong> Yeah. I think something would have to happen really quickly. We\u2019re seeing some politically vulnerable Republicans, in the House, specifically, say that they want at least a year-long extension. It\u2019s just a really difficult issue. We know, obviously, the Freedom Caucus is already making threats about it. They hate the ACA, maybe more than anything. It\u2019s going to be really interesting how this turns out. I\u2019ve also heard that maybe there might be a paired-back version of an extension that they could do, maybe messing with some of the income parameters. But I don\u2019t know if that kind of compromise would be enough unless Republicans work with Democrats, which as we already said is complicated for other reasons. So it\u2019s just a mess right now.\u00a0<\/p>\n
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